2. Nasopharynx

Question 1

Disease of the nasopharynx

Answer 1

1. Inflammatory conditions
   a. Pharyngitis
   b. Tonsillitis
2. Neoplasms
   a. Juvenile angiofibroma
   b. Nasopharyngeal carcinoma (most common)
   c. Lymphoma

Question 2

Causes of pharyngitis, tonsillitis

Answer 2

1. Viral (rhinovirus, adenovirus, echovirus, respiratory syncytial virus, influenza virus)
2. Bacterial (beta-hemolytic streptococci, Staphylococcus aureus, tuberculosis)

Question 3

Complications of pharyngitis, tonsillitis

Answer 3

Streptococcal pyogenes pharyngitis may lead to development of late sequelae:

1. Acute rheumatic fever (rheumatic heart disease)
2. Acute glomerulonephritis

Question 4

Juvenile angiofibroma

Answer 4

1. Benign tumour
2. Occurs almost exclusively in adolescent males
3. Highly vascular tumour with a tendency to bleed profusely during surgery

Question 5

Epidemiology of nasopharyngeal carcinoma

Answer 5

1. Most commonly found in parts of Africa (where it mainly afflicts children) & southern China (where it mainly afflicts adults)
2. Predisposing factors: environmental, genetic, Epstein-Barr virus infection

Question 6

Histological types of nasopharyngeal carcinoma

Answer 6

1. Keratinizing squamous cell carcinoma
2. Non-keratinizing squamous cell carcinoma
3. Undifferentiated carcinoma (has an abundant, non-
   neoplastic lymphocytic infiltrate surrounding nests of undifferentiated neoplastic cells)

Question 7

Clinical features of nasopharyngeal carcinoma

Answer 7

1. May remain asymptomatic due to location
2. Cervical lymphadenopathy
3. Naso-respiratory symptoms (bleeding, nasal obstruction)
4. Neurological symptoms (headache, nerve palsies)
5. Auditory symptoms (Eustachian tube obstruction, earache, tinnitus, deafness)
6. Standard treatment modality is radiotherapy (undifferentiated type is most radiosensitive, keratinizing type least)
7. Poor prognostic signs: lymph node & distal metastases